Cognitive Behaviour Therapy

Cognitive behaviour therapy (CBT) is a popular, evidence-based therapeutic approach, which has been found to be quite effective in treatment of a variety of problems. Research suggests that CBT is effective for the treatment of conditions like depression, substance use, anxiety disorder, anger and aggression, chronic pain and fatigue, general stress, eating disorders, insomnia, etc.

CBT is founded on the perspective that maladaptive cognitions contribute to maintenance of emotional distress and behavioural issues. These maladaptive cognitions include general beliefs about the world, self and the future. They give rise to specific and automatic thoughts in certain situations. The model states that these maladaptive cognitions can be changed and restructuring. This restructuring leads to changes in emotional distress and problematic behaviours.

A number of research studies suggest that CBT helps in significantly improving functioning and quality of life. It has been demonstrated to be as effective, and in some cases more effective, than other forms of psychological treatments or psychiatric medication.

CBT can be useful in different ways. Common uses of CBT include:

Managing symptoms of mental illness
Preventing a relapse during and after treatment
Managing chronic physical symptoms
Coping with grief or loss
Learning ways to cope with stressful life situations
Identifying strategies to better manage one’s emotions
Resolving relationship conflicts
Learning better ways to communicate
Overcoming emotional trauma related to abuse
Coping with medical illness
Treating a condition when medications aren’t a good option

Does CBT work for social anxiety?

First of all, we need to clear out the confusion around shyness, introversion and social anxiety. Some shyness is natural in certain novel and unfamiliar situations. Introversion is a stable personality trait. Shyness and introversion are natural and harmless, not something to be treated. Social anxiety on the other hand, is a mental health condition that requires professional treatment.

One suffering from social anxiety goes through extreme and persistent feelings of worry, dread and nervousness. The feelings can show up during social situations or even while simply thinking about being in social situations.

Other symptoms of social anxiety include:
being disturbed by thoughts of how others perceive you
having fear around embarrassing yourself
feeling extremely self-conscious around others
fear of being rejected
fear of being laughed at
physical symptoms of anxiety (like restlessness, shortness of breath) during social situations
avoiding social situations

The treatment for social anxiety can be done through therapy, medication or a combination of both. One of the most effective therapy for social anxiety is Cognitive Behavioral Therapy (CBT). It teaches one to identify specific thoughts, emotions and behaviours that cause discomfort. Thereby, the thoughts and beliefs can be reframed into more helpful ones.

A lot of evidence shows that CBT is an effective treatment for social anxiety.

In 2014, 101 studies were evaluated during a research review in which 41 different treatment approaches like medication, self-help, meditation, etc. were reviewed. CBT appeared to have the most benefit in treatment of social anxiety.

CBT was compared to exposure therapy in a research in 2015 which suggested that CBT may be more helpful in relieving symptoms of social anxiety.

CBT can be a quick and effective treatment as suggested by a small 2015 study. The study found that even 6 sessions of CBT may help reduce the feelings of self-consciousness and avoidance. However, fears of criticism or negative evaluation might not be completely erased.

A study in 2016 focused on 42 adults suffering with social anxiety. It suggests that the symptoms of the condition which don’t respond to anti-depressants could better be treated with CBT.

Common techniques from CBT which help with social anxiety are:
Cognitive restructuring
This helps in identify unhelpful and inaccurate patterns of thinking and in reframing them to useful and more accurate ones.

Systematic desensitisation
One learns relaxation techniques, and then is progressively exposed to the feared social situations, thus becoming more familiar and comfortable with them.

Behavioural experiments
These help in identifying unhelpful behaviors and testing new helpful behaviour patterns in social situations.

Attention Training
This helps in shifting one’s attention back to others which further helps in being less self-conscious.

Does CBT work for depression?

Cognitive Behaviour Therapy (CBT) is one of the most evidence-based psychological interventions for treatment of disorders like depression, substance abuse, anxiety, etc. It is used for treatment of many other conditions like marital discord, stressful life situations, and psychotic disorders.

A good number of researches show that CBT is effective in treatment of depressive disorders. A meta-analysis of 115 studies has shown the efficacy of CBT for depression.
When combined with pharmacotherapy, it is found to be more effective than pharmacotherapy alone. Evidence has also been found for lower relapse rate of patients treated with CBT in comparison to those treated with pharmacotherapy alone.

Advantages of cognitive behavioral therapy in depression

  1. CBT helps in reducing symptoms of depression. It can be used as an independent treatment or in combination with medications.
  2. Depression is maintained by certain underlying schemas or beliefs. CBT is used to modify these schemas and beliefs.
  3. It has been found to be helpful in addressing various psychosocial problems like marital discord, job stress, etc. which can contribute to the symptoms of depression.
  4. CBT is useful in reducing the chances of relapse and recurrence.

Psychological interventions are commonly used for mild to moderate depressive episodes.
Clients with comorbid severe personality disorders such as antisocial personality disorders and subnormal intelligence are difficult to manage through CBT. Similarly, a client with severe depression with psychosis and/or suicidality might be difficult to manage with CBT alone and may need medications and other treatment.

Psychotherapy: What It Is and How It Works

We all face some issues and challenges in our lives. While facing those challenges, often we don’t know what to do or we do know what we can do to improve the situation but are not able to do so. Our thoughts, feelings, emotions and behaviours come in the way of taking effective action.

For example, we know we shouldn’t eat too much sugar to keep ourselves healthy but still end up having too much of it. We do know that we should communicate clearly, assertively and compassionately in order to maintain healthy relationships but end up reacting, blaming, complaining, etc. We do know that we need to save and invest our money wisely but end up spending not so carefully.

Then there are difficult situations like losing someone close to us, or going through traumatic events like abuse or an accident. There are difficult feelings and emotions like loneliness, anxiety, depression, grief, betrayal, etc.

Therapy is a collaborative relationship between a therapist and a client in which various tools and techniques are used to help and support the client deal with their issues and challenges. While scientific evidence based tools and techniques do have a role to play, it’s the strength of the alliance between the therapist and the client that has the greatest impact.

Just the act of opening up in a safe and non-judgemental space, and being received with acceptance and positive regard, can bring about beneficial changes in the person seeking therapy. One can be fortunate enough to find a few moments of such therapeutic value in their relationships. However, therapy is often the first relationship for many people where they have a space to discuss what they are going through freely.

As children, most of us didn’t have people around us that listened to us, set the right boundaries or helped us feel lovable and worthy. The therapist is experienced as the first truly supportive and reliable person we so need and want. We can then regress back to earlier moments and finish unfinished business, relive the moments and repair the damage or meet the unmet needs.

Now we can express who we are, feel our feelings and allow thoughts to come, leave or be given a voice. This one healthy relationship becomes a model for relationships outside therapy room. Our inner voice becomes kinder, calmer, more intelligent. Distorted perceptions get grounded in reality.

As therapy progresses, we grow up, psychologically.